Emergency Department Red Phone Notifications 31
Selection of the Core MCI Notification Group 32 □ This is OPTIONAL and meant to enhance internal activation and expedite response. □ Simultaneous notification for all FDNY MCI communications via Sit Stat (event start, update, and end/stand-down) □ Recommended departments and 24-hour roles □ ED Nursing Station, ED Triage Station, Hospital Telcom, Central Security Station, 24/7 EM function, Director or Administrator on Call □ Delivery methods: computer webpage pop-ups, email, text/pager, voice
Using Sit Stat to Expedite Current Notification Processes 33
Thank You 34 For questions, please contact: Jenna Mandel-Ricci 212-258-5314 jmandel-ricci@gnyha.org Samia McEachin 212-258-5336 smceachin@gnyha.org
Report – out on BP1 SUPP Deliverables DARRIN PRUITT, DEPUT Y DIRECTOR, BUREAU OF HEALTHCARE SYSTEM READINESS, NYC DOHMH LES WELSH, EMERGENCY RESPONSE COORDINATOR, OEPR, BUREAU OF HEALTHCARE SYSTEM READINESS, NYC DOHMH TIMOTHY ST YLES, MEDICAL DIRECTOR, OEPR, BUREAU OF HEALTHCARE SYSTEM READINESS, NYC DOHMH 35
Data provided to DOHMH via deliverables in BP1S (July 1, 2018 to June 30, 2019) - NYC hospitals & networks Deliverable 4: Contact information Deliverable 6: Citywide surge exercise Deliverable 7: Training and planning for training Deliverable 8: Protocols for EMResource for MCI notifications Deliverable 9: Mass fatality planning 36 36
Contact information, BP1S (July 1, 2018 to June 30, 2019) - NYC hospitals & networks Hospitals providing updates to their contact info - 53 Focus area, BP1S was infectious disease related data. Hospitals with contacts for… Infectious disease 47 • Infection control 55 • Hospital epidemiologist 50 • Clinical lab 53 • Microbiology lab 49 • 37 37
Deliverable 6: Citywide Surge Exercise Data Healthcare facility participants: 55 hospitals & 7 networks Evacuating hospitals: 22 • Receiving hospitals: 33 • Initial patient census Evacuating hospitals: 5,874 patients • Receiving hospitals: 10,254 patients • Top 3 most common bed categories Adult medical / surgical: 9,406 • Adult critical care: 1,649 • 38 Adult psych: 1,508 • 38
Deliverable 6: Citywide Surge Exercise Data Top 3 hardest bed matches Perinatal NICU (levels 1 &3) • Adult addiction • Geriatric psych • Top 3 easiest bed matches Adult rehabilitation: • Adult medical / surgical • Adult critical care • Percent of unmatched transportation requests by TAL TAL 1: 27% • TAL 2: 7% 39 • TAL 3: 66% • 39
Data describing training in BP1S (July 1, 2018 to June 30, 2019) – NYC hospitals & networks Response/submitted deliverable: 82% Topics ranked by numbers trained 1. Emergency Management & Staff trained Workplace Safety (28,593) • All: 47,345 2. Active shooter (7,678) • Networks: 38,028 3. Infection Prevention & Control (3,930) • independent hospitals: 9,317 4. HICS (3,831) Clinical v. non-clinical • Clinical: 22,607 • Non-clinical: 24,738 40 40
Deliverable 8: Develop protocols to reflect use of EMResource for MCI Notifications Independent Hospitals Network Hospitals Participating hospitals Participating hospitals • 911-receiving 9 of 12 • 911-receiving 37 of 37 • Non 911-receiving 3 of 3 • Non 911-receiving 2 of 2 Hospital t tex ext, Red ed ph phone Hospital t tex ext, Central l Re Red email, o ema or app pp only ly ema email, o or app pp Monitorin ing b by phon hone notifica cation notifica cation EM s staff only ly 911-receiving 7 2 911-receiving 23 9 5 41 non 911 3 N/A non 911 2 N/A N/A 41
Deliverable 9: Mass Fatality Planning Independent Hospitals ls (12 of 15 partic icip ipat ated) Network Hospitals (39 of 3 39) p participat ated) Average Onsite Capacity: 11.5833 Average Onsite Capacity: 15.15 Number expecting to request BCPs: 12 Number expecting to request BCPs: 26 Number that submitted Long/Lat for BCP Number that submitted Long/Lat for BCP location: 12 location: *37 Number Indicating BCP location is: Number indicating BCP location is (of 26): Adjacent to Loading Dock: 7 Adjacent to Loading Dock: 19 Has Public View Concerns: 6 Has Public View Concerns: 10 Has Security Cameras: 12 Has Security Cameras: 22 Close Proximity to HVAC: 3 Close Proximity to HVAC: 9 Access to Grid Power: 7 Access to Grid Power: 15 Facilities have identified staff for BCP or Facilities have identified staff for BCP or developed JIT training? 12 developed JIT training (of 26)? 11 42
Networking Break
Infectious Diseases: What’s on the Radar MARY FOOTE, SENIOR MEDICAL COORDINATOR FOR COMMUNICABLE DISEASE PREPAREDNESS, BUREAU OF HEALTHCARE SYSTEM READINESS, NYC DOHMH 44
What’s on Our Radar?? RECENT OUTBREAKS AND INFECTIOUS DISEASE UPDATES Mary Foote, MD, MPH
Candida auris 46
Candida auris Emerging fungus that presents a serious global health threat for 3 main reasons: Often multidrug-resistant, including those commonly used to treat Candida 1. Difficult to identify with standard laboratory methods 2. Causes outbreaks in healthcare settings REALLY hard to get rid of 3. Invasive infections are associated with high morbidity and mortality Assessment and messaging are complicated due to many unknowns and distinction between active infection and colonization 47
Candida auris in NYS NYS has the highest burden in the US As of August 16, 2019, 378 78 clinical cases and 51 514 screening cases in NYS As of September 11, 2019, 799 799 clinical cases in the US Primarily concentrated among interconnected hospital and nursing home in NYC 48 48
C. Auris - What’s the Risk? Risk factors: Time in hospitals/post-acute care with lines or tubes Others: recent surgery, diabetes, broad-spectrum antibiotic and antifungal use Aim of control is to protect vulnerable patients • Infection control • antimicrobial stewardship 49
MEASLES OUTBREAK Measles New York City, 2018-2019 50
B ACKGROUND : 2018-2019 M EASLES O UTBREAK Large measles outbreaks in Israel • >4,100 cases from March 2018 through April 2019 • Orthodox Jewish community Outbreak in NYC • 654 654 cases, as of August 2019 • Began in October 2018 with an unvaccinated child from Brooklyn who acquired measles in Israel • Multiple importations from Israel, UK, Ukraine, Rockland County, NY and NJ • Largest U.S. outbreak since 1992* *CDC. Measles—United States, 1992. MMWR 1993 51
F OCUS IN O RTHODOX J EWISH NEIGHBORHOODS W IL ILLIAM AMSBURG AND ND B OROU OUGH P AR ARK , , B ROOKLYN Previous community transmission in Sunset Park (mostly non- Orthodox Jewish) 52
Demographics of Cases Gender • Overall: 61% male, 39% female Orthodox Jewish religion* • Overall: 93% Orthodox Jewish Hispanic* • Overall: 6% Hispanic *Assumed based on name, language spoken; not necessarily by self-report As of July 29, 2019 53
Why Did This Outbreak Occur? Multiple importations Vaccine delays and hesitancy Antivaxx propaganda materials Spreading of misinformation and anti-vaccination propaganda Multiple exposures Large household size, congregate gatherings Parents not seeking medical care for infected children Retrospective cases identified through serology • No opportunity to implement control measures 54
M EASLES C ASES B Y D ATE OF R ASH & NEIGHBORHOOD N=642 Emergency Order Yeshiva Exposure *As of July 29, 2019 55
Why Didn’t the Outbreak Spread? Largely limited to Orthodox Jewish communities in Williamsburg and Borough Park, Brooklyn • Insular communities High overall vaccination rates in NYC Public/charter schools: 98.7% compliance with school immunization requirements* Private schools: compliance and complete vaccination with school immunization requirements • All private schools: 98%, 94% (all antigens) • Orthodox Jewish schools: 97% MMR, 92% (all antigens) 56
Complications *As of July 29, 2019 Otitis media: 62 Hospitalizations: 52 Diarrhea: 94 • ICU admissi ssions: s: 1 19 No deaths occurred in NYC Pneumonia: 34 57
Post Measles Complications Subacute sclerosing panencephalitis (SSPE) • Rare but fatal complication • Develops 7-10 years after measles infection Impact on immune response Immune-amnesia theory • Knocks out cells that produce antibodies • Your immune system can’t recognize and fight off infections it’s already been exposed to (or vaccinated against) • Effect can last up to 2-3 years 58
Exposures >21,000 exposed persons* • Mainly in medical facilities • Highlights importance of screening Factors associated with these exposures • Lack of negative pressure rooms • Exposures before rash onset • Inadequate isolation and delays in case reporting 21 cases acquired in healthcare facilities *As of June 10, 2019 59
Healthcare System Support Cadre of healthcare facility liaisons (MDs and nurses) Deployed DOH staff at a high volume facility at the epicenter of the outbreak to assist with potential exposures Healthcare guidance developed • Clinic and hospital screening protocols • Infection control • Healthcare worker immunity MRC staff to support entry screening at 2 outpatient clinics On-site infection control assessments and technical assistance 60
Outpatient Measles es Readines ess A Asses essmen ent Inf nfection Co Cont ntrol Gui Guidance Pr Provider er Web ebinar ar an and Cal alls 61
Inpa pati tien ent a t and O Outpa pati tien ent T t Triage a e algorith thms ms 62
Provider Outreach Multiple health alerts and presentations to clinicians Multiple guidance documents Reminders to recall unvaccinated patients Clinical and infection control consultation Distribute posters and pamphlets in English and Yiddish to medical facilities Ensure providers have enough MMR vaccine on hand Assist with post-exposure prophylaxis for exposed persons 63
Community Outreach and Engagement Print ads and social media specific to Orthodox community Press release, media interviews/articles Met with rabbinical and community leaders, elected officials Partner with Jewish Orthodox Women’s Medical Association and Vaccine Task Force on educational outreach Distribute 29,000 copies of pro-vaccination booklets geared to Orthodox community 64
Credit: The Vaccine Task Force of the nyc.gov/health/ EMES Initiative measles (Engaging in Medical Education with Sensitivity) 65
Increases in Vaccination in Children* NYC, Citywide • 88,412 MMR doses administered • Represents an additional 22,522 doses vs. the same period last year (34% increase) Williamsburg, Brooklyn • 5,513 MMR doses administered • Represents an additional 2,307 doses vs. the same period last year (72% increase) *April 9, 9, 20 2019 9 (e (emergency or order issued) to J o July 29, 29, 20 2019; 9; Ages 6 months to 18 years 66
Lessons Learned Identify population and communities at risk • Sources: school immunization compliance, NYC Citywide Immunization Registry • Geography, religion, or ethnicity Cultural sensitivity, translations Establish relationships before an outbreak • Providers • DOH Liaison • Community engagement • Including organizations and leaders 67
Lessons Learned Risk communication • Don’t underestimate the power of misinformation • Provide swift and culturally appropriate counter messaging • Meet affected communities where they are • Be mindful of stigma risks Integrate social sciences into preparedness and response • Provide providers with tools to discuss vaccines • Counter vaccine hesitancy Infection control, infection control, infection control!!! 68
Breaking News June 13, 2019 69
What’s on Our Radar? 70
Ebola in the Democratic Republic of the Congo (DRC) August 2018 outbreak declared Outbreak near int nter ernat national nal bor border ders July 2019 Declared Public Health Emergency of International Concern Not considered as global threat Total cases = 3,168, Deaths = 2,115, CRF = 67% Geographical distribution of confirmed and probable cases of Ebola virus disease, Democratic Republic of the Congo and Uganda as of 18 September 2019 71
Ebola in DRC: Challenges Insecurity +++ • Community distrust of authorities • Violence against health workers, resistance to vaccination and treatment, Infection of health care workers • Healthcare transmissions, unregulated/informal care Unknown chains of transmission • 30-40% of cases are known contacts • Community deaths Wom omen n and and chi hildren n disp sprop opor ortionat nately af affected • 62% female (caregivers, funeral attendance) • Children accounting for 40% of deaths 72
Measles in DRC Significant breakdown in public health systems • Measles immunization rate of 57% in 2018 Now the worlds largest outbreak of measles Has caused >3,500 deaths more than Ebola • All in children Symptoms can be confused with Ebola Possible increase in susceptibility to Ebola?? Credit: WHO Africa 73
Ebola Vaccines Merck’s V920 vaccine being used for ring vaccination (aka: rVSV-ZEBOV-GP) Protection in ~10 days Has been >97% effective Merck applied for FDA approval • could come as early as March, 2020 Johnson & Johnson vaccine to be deployed for “at-risk” populations https://www.who.int/csr/resources/publications/ebola/ebola-ring-vaccination-results-12-april-2019.pdf 74
Promising Ebola Therapeutics PAL ALM Trial (N (November 2 2018) ) Mortality rates from 499 patients Randomized control trial at 4 Ebola REGN-EB3 = 29%* treatment centers (ETCs) mAb114 = 34% 4 experimental treatments Zmapp = 49% • 3 Ebola antibodies + 1 antiviral Remdesivir = 53% medication August 2019 study halted • Two treatments will continue in *Mortality 6% with early initiation expanded trial at all ETCs 75
Influenza and Pandemic Preparedness 76
Fl Flu u 2019-2020 2020 Bad season in Southern hemisphere What does that say about North Flu 2019-2020 American season? 77
Pandemic Preparedness Chances of global pandemic increasing • Not just influenza 2019 analysis of global systems • Found weakness in political, financial and logistical state of pandemic preparedness Impact of pandemic similar to 1918 • 80 million deaths • Cost 4.8% of global GDP ($3 trillion) Global call to action https://apps.who.int/gpmb/annual_report.html 78
Resources for outbreaks and travel-related illnesses DOHMH Current New York City, U.S., and International Infectious Disease Outbreaks : https://www1.nyc.gov/site/doh/providers/reporting-and-services-main.page Travel Clinical Assistant (TCA): dph.georgia.gov/TravelClinicalAssistant CDC Travel Health Notices: www.cdc.gov/travel/notices HealthMap (search for outbreaks by region, state or country): healthmap.org ProMED: promedmail.org 79
Questions? Mfootemd@health.nyc.gov • 347.396.2686 80
Strategizing for BP2 - Growing the NYCHCC into an operational response coalition CELIA QUINN, EXECUTIVE DIRECTOR, OEPR, BUREAU OF HEALTHCARE SYSTEM READINESS, NYC DOHMH 81
NYC Health Care Coalition Update
Vision Move the NYCHCC toward a more functional, operational model that can better support members in preparedness and response All NYCHCC members are able to contribute to the development of annual workplan and budget that supports our shared goal of a prepared and resilient healthcare system in New York City Working collaboratively, the NYCHCC identifies the highest impact projects to fund with increasingly limited federal funds What can we achieve if we are able to do this? • Fund joint projects that serve the collective: situational awareness function, improved medical coordination, joint purchasing, standardized training, etc • Make meaningful progress toward a robust healthcare response to emergencies 83
Background and Purpose DOHMH is seeking to increase the involvement of NYC Health Care Coalition (HCC) members in the development of the annual application for HPP funds • Provide input to the budget proposal • Assist in developing grant application workplans and activities for funded projects Activities, projects, and budget proposals are constrained by National HPP and must: • Meet all program requirements at Recipient and HCC level • Follow federal regulations for use of grant funds Today we will take a step in that direction by reflecting on recent projects and activities, and discussing a few possibilities for NYCHCC priority projects for BP2 84
Where we are and how we got here…. 85
Previous Approaches Broad stakeholder engagement at strategic level • Healthcare Coalition development process (2012) • Healthcare Readiness Project (2014) • NYC HPP Program restructuring (2015-2016) • Healthcare System Playbook (2017) • Strategic Planning for Facilities and Medically Vulnerable Populations unit (2018-2019) DOHMH takes responsibility for ensuring that program activities meet Federal requirements and align with local priorities set through strategic planning processes • Building in flexibility for sub-recipients to address unique needs • Involving sub-recipients in annual planning 86
Why change approach now? Federal program requirements and local needs are becoming more focused on system-wide or Citywide solutions Evolving NYC HCC structures allow for improved member input while retaining focus on system-wide impact New 2019 – 2024 project period should allow for longer-term planning than has been possible during recent years 87
Recent Accomplishments Restructured the Governance Board to include permanent seats for agency representatives Eliminated “HMExec” • HMExec functions are now owned by the Governance Board Documented changes in the NYC HCC Charter, approved by Governance Board members Completed the NYC HCC Response Plan, approved by Governance Board members 88
Current NYC HCC Governance Board Members Permanent Members Elected Members (2-year terms) NYC DOHMH Networks – Walter Kowalczyk NYC Health + Hospitals Independent Hospitals – Pat Roblin GNYHA Borough Coalitions – Pia Daniel FDNY Long Term Care – Gabe Oberfeld NYS DOH (non-voting) Pediatrics – Mike Frogel Agency Partner Primary Care – Alex Lipovstsev NYC Emergency Management 89
NYC HCC Leadership Council Network Leads Borough Leads Independent Hospital EPCs Pediatric Disaster Coalition North HELP Community Health Care Association of NY State Nursing Home Associations 90
NYCHCC Functional Organization Charts 91
Current NYCHCC Subcommittees Evacuation and Surge Steering Committee Coalition Surge Test (SurgeEx2020) Planning Team Medical Surge Planning • Essential Elements of Information Borough lead coordination Health System (network) lead coordination Coalition Planning Committee 92
What we are doing now… 93
Definitions Recipient: NYC Department of Health and Mental Hygiene, through Public Health Solutions (fiscal agent) Sub-recipient: organization that receives HPP funds from DOHMH with the expectation of meeting certain program requirements Healthcare Coalition: In NYC, this refers to the NYC Health Care Coalition (not the sub-coalitions that are members of the NYCHCC Leadership Council) Recipient Level Direct Cost Cap: Recipient (DOHMH) may only retain 18% of the total award for personnel, fringe and travel costs, unless a waiver is granted by ASPR with support from HCC members Fiscal agent: use of an independent fiscal agent to receive federal funds on behalf of DOHMH substantially reduces the burden of financial processes on the obligation and liquidation of funds 94
Annual HPP Requirements for New Project Period Update and maintain Hazard Vulnerability Analysis HCC member organizations must have access to information sharing platforms used by the HCC Update and maintain resource inventory assessment Provide a communication and coordination role within Engage health care delivery system clinical leaders; jurisdiction; intended to interface with the ESF-8 lead engage community leaders agency Update and maintain Preparedness Plan and Charter, For any purchases of supplies, document inventory and membership roster management protocols, policies, etc Submit list of planned training activities Incorporate surge staffing into HCC and member response plans Update and maintain Coalition Response Plan Submit each HCC’s full Scope of Work (including all Define procedures for sharing Essential Elements of HCC requirements) with the application for the Information (*Note that this refers to specific EEIs that subsequent budget period – early February each year! we will get from ASPR by the end of September, 2019) Coalition Surge Test 95
BP1 HPP Requirements Address planning for a Pediatric surge in the HCC Response Plan (or annex) Validate Pediatric Care Surge Annex in a standardized tabletop/discussion exercise format and submit results and data sheet to ASPR Complete HCC Surge Estimator Tool by January 1, 2020 (and every 2 years after that) 96
HPP Requirements for BP2-5 Joint HPP/PHEP exercise (once per project period) Complete a supply chain integrity assessment (BP3) Develop procedures to rapidly acquire and share Healthcare System Recovery Plan (BP4; recipient clinical knowledge between health care providers and requirement) organizations during response (BP2) Additional Medical Surge Annexes (or incorporate into Crisis Standards of Care Concept of Operations (BP2; medical surge response plan), validated by recipient requirement) standardized tabletop/discussion exercise: • Burn annex (BP2) Integrate jurisdictional Crisis Standards of Care elements into HCC plans (BP3) • Infectious Disease annex (BP3) • Radiation Annex (BP4) Test Crisis Standards of Care plan in coalition-level • Chemical Annex (BP5) exercise (BP3) Provide PIO training to HCC members (BP3) HCC Continuity of Operation (COOP) plan (BP3) 97
Current Budget Period 1 Budget BP1 Award = $7,501,609 $695 95,90 905. 5.00 0 $1,468 68,85 857. 7.00 0 Personnel, l, F Fringe, and T Trav avel ( l (20%)* Fiscal l Agent I Indirect ( (6%) $450 50,09 097. 7.00 0 Coali alition M Membe bers ( (65%) Misc: S : Supplies, t , techn hnical assi sistance programs ms, t trainings f s for HC HCC me memb mbers, $4,886 86,75 750. 0.00 0 exercise s suppor ort, m meeting an and w webs bsite, e etc (9%) *DOHMH indirect, included here, is not counted as part of the Recipient Level Direct Cost Cap 98
Personnel, Fringe and Travel Total budget: $1,468,857 (20% of total award) Funds 9.5 DOHMH FTEs dedicated to program development and management Staff r roles es Typical s staff responsibilities Unit Director (3.75) Develop programming funded on HPP award • Ensure that HPP program requirements are met and support NYC priorities Project manager (4) • Oversee contracted work to ensure quality, timeliness, and impact • Coordinator (1.75) Coordinate across HCC members to share promising practices • Work with local, state, and federal partners on healthcare system readiness during real emergencies, planned • events, and preparedness exercises Develop and oversee innovative technical assistance programs to support facility-level readiness • Funds 1.15 DOHMH FTEs dedicated to program administration (Grant staff and DC) Small amount of funds to cover required travel and training for staff DOHMH employees on other funding streams also support DOHMH’s participation in the NYC Health Care Coalition 99
Technical Assistance Programs, Supplies, and Training for HCC Members Total Budget: $695,905 (9% of total award) Includes: • Long Term Care Exercise Program (up to 75 facilities) • Long Term Care Hazard-Specific Training Program (available to LTCs and FQHCs; up to 100 participants) • Support for coordination of and reporting on Coalition Surge Test • Adult Care Facility conference • Design and formatting guidance documents for Pediatric and Primary Care sectors • Maintenance of website and support for Leadership Council and EPS meetings • Emergency response supplies for Long Term Care and Community Health Center participants in programs 100
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